Utilization Management Support Technician

This is a fully remote position, open to applicants in Florida.

📋 Description

• Facilitate the process for utilization management requests for coverage, supporting all lines of business, and entering authorizations into the claims platform while managing communications between members and providers.

• Assist members enrolled in specialty management programs by coordinating necessary prior authorizations with the UM team, ensuring prescription fulfillment with specialty pharmacy partners, enrolling in patient assistance programs, and addressing billing inquiries.

• Collaborate with Pharmacy technicians, Pharmacists, and/or Medical Directors on utilization management activities.

• Make outbound calls to provider offices to gather clinical information that is missing from submitted UM cases.

• Ensure that cases are reviewed in accordance with State and/or Federal guidelines, including adhering to turnaround time requirements.

• Engage in quality review and inter-rater reliability processes.

• Manage a provider call center, responding to prescriber inquiries regarding the status of UM requests.

• Guarantee that regulatory and privacy standards are consistently upheld.

⛳️ Requirements

• 1-2 years of experience as a pharmacy technician in a PBM, pharmacy department of a health plan, or a similar managed care environment. Alternatively, 1-2 years of experience in a mail order or specialty pharmacy.

• Current (National) Certified Pharmacy Technician (CPhT) certification.

• Detail-oriented, critical thinker with empathy, capable of thoroughly understanding issues to identify true root causes and resolutions, with a commitment to enhancing a patient’s healthcare experience and delivering concierge-level service.

• Familiarity with pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multitask and prioritize work, and capability to work independently.

• An Associate’s or Bachelor’s degree is preferred.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment that values teamwork and collaboration.